I fell into writing about health shortly after grad school, where I realized I didn't want to work in a lab for the rest of my life! My areas of interest are the brain and behavior, as well as what influences the decisions we make about our health, and how the media helps and hinders people's understanding of health issues. As an undergraduate, I studied English Literature and Biopsychology at Vassar College, and got my PhD in Biopsychology and Behavioral Neuroscience at CUNY's Graduate Center in New York City, where I grew up and live now. My day job is as Associate Editor with the health website, TheDoctorWillSeeYouNow.com. My work has appeared in several other publications, including TheAtlantic.com and YogaGlo.com, and I'm particularly excited to join the Forbes health team. Email me at alicegwalton [at] gmail [dot] com .

Time To Pay Attention: What The Newest ADHD Research Is Telling Us

Yesterday, a nicely executed study came out showing that ADHD persists into adulthood for about 30% of people who have it as kids. Not only does it persist, but regardless of whether it followed them into adulthood, people who suffered from it as children had a greater risk of other mental health issues, like anxiety, depression, antisocial personality disorder, substance abuse, and possibly even suicide. The risk of having a psychiatric disorder as an adult was, of course, much higher if ADHD persisted into that stage of life.

These connections aren’t exactly news: Other studies have arrived at similar results, but they’ve varied so greatly in the methods they used and the connections they found that it’s been hard to know the actual rates and risks of comorbidities over the long-term. So, the fact that the new study, done by researchers at Mayo Clinic and Boston Children’s Hospital, used more reliable means (it was a large-scale, prospective study that followed kids into adulthood and quizzed them about their psychiatric health then and there) to arrive at the findings mentioned above is a boon to ADHD research. Child and adolescent psychiatrists and psychologists have been pretty well aware of the connection for years, but it’s good to have a well-designed study support it strongly.

So the question is then, what are we supposed to do with all this? How do these accumulating studies affect our understanding of the disorder? The short answer is that it’s probably pretty well time to revamp our approach to ADHD, which at the moment leaves a lot to be desired. Seeing ADHD as a chronic health problem whose earliest symptoms can be often be present around age three (and should be intervened with right then, in ways involving the whole family) is really what these studies are trying to get us toward.

A Relentless Trajectory

Part of the complication with childhood ADHD is that there can be more than one mental health issue going on. John T. Walkup, MD, the Director of the Division of Child and Adolescent Psychiatry at Weill Cornell Medical College and New York-Presbyterian Hospital (not affiliated with the study mentioned above), tells me that one of the issues is that we need to sort out what’s ADHD and what’s not. “There’s the hyperactive impulsive type of behavior, which is the most malignant,” he says. “These kids develop problems with disruptive behavior. If they don’t get treated, they accumulate disability at a relentless pace.” (More on this in a sec.) Then there are other kids who appear to be inattentive, but the underlying cause may be something else – like anxiety. “Anxious kids may also be off task, because they are worried, preoccupied, and restless. But they’re not really hyperactive.” Sorting out the cause of inattention in youngsters is one of the issues that deserve closer attention.

But back to the more “malignant” form of ADHD. Kids who fall into that category often experience the double whammy of having honest-to-goodness attention problems, a lack of emotion and behavior control, and experiencing the lifelong fallout of having the problems, which might be worse than having the problem to begin with. The psychological fallout can involve inadequate treatment or mis-medication, inadequate parenting, and a mishmash of problems at school. When kids start to see themselves as “bad” or “troubled,” things get worse. “They’re told they don’t ‘behave’,” says Walkup. “They don’t connect with parents, or peers; their social and academic status slips. They experience lots of failure over the years. It’s a relentless trajectory that can include oppositional defiant disorder, conduct disorder; they also have higher risk of alcohol and drug abuse. White males are typically the highest risk group.”

It’s a cycle that can last for a lifetime, and may be part of the reason that kids with ADHD have comorbidities like depression, anxiety, and even suicide risk, says Walkup. “These kids become demoralized and alienated if they don’t get good treatment. If you can relieve them of their burden, you will go a long way to improving their outlook and their behavior.”

Stopping the Cycle

Interrupting the ADHD cycle before it ends in demoralization – and, of course, depression or suicide – is the obvious answer. It may not prevent everyone with ADHD from developing another psychiatric issue, but it could reduce the numbers quite a lot. How to best nip it in the bud is up for debate, but the mental health community is beginning to work it out.

William Barbaresi, MD, Director of the Developmental Medicine Center at Boston Children’s Hospital and Associate Chief, Division of Developmental Medicine at Boston Children’s Hospital, who headed the new study, stresses that we need to overhaul our understanding and approach to ADHD intervention and treatment. “One of the major obstacles is that there continues to be, in the media and the general public, this trivialization and sensationalization of ADHD as an overblown problem that’s being over-treated. But, as we’re understanding more and more, this is a serious chronic problem that begins in childhood and persists into adulthood. For example, in our study, 80% of those individuals with persisting ADHD had other mental health diagnosis. And even for those whose ADHD didn’t persist, 47% still had another psychiatric diagnosis. We have got to create a system that’s designed to treat ADHD as chronic health issue, not just a kid disorder.”

And as with chronic health issues of other varieties, there are often very early clues. ADHD is no exception. Walkup points out that early symptoms can be seen in kids as young as three years old: the “dysregulated behavior” that’s often evident early on can be a very good predictor of what’s to come.

“Preemptive treatment is where the action is,” says Walkup. “This is much more effective than ‘fixing’ the problem after the fact. All these problems have early onset. We can really cut our health care burden enormously if we pay attention and intervene early.” Walkup points out how we have no problem calling a spade a spade with early signs of heart disease or diabetes – two famously chronic health conditions that benefit from early treatment if warning signs are heeded. But when it comes to ADHD (like any other psychiatric issues), suddenly “labeling” is a problem. “We suspend our medical logic when we get to these kinds of problems,” he adds. “But medical logic actually works very well here.”

Barbaresi also makes the point that the state of health insurance isn’t helping matters any, since, he says, “in the US, it doesn’t cover in-depth testing – if you’re a parent and you’re referred to my center, I’m not permitted to do in-depth psych testing. Even though we know 60% of the kids I see will develop a learning disability or other mental health issue, I can’t obtain authorization to perform the psychological testing that children need at that stage.”

One way to address psychiatric problems early, says Walkup, is to ask parents at their newborn’s first “well baby” visit about their own psychiatric histories. “Maybe dad had attention problems when he was young, but didn’t get treatment; maybe mom has anxiety disorder. They’re both people who are struggling. If I were a pediatrician, I’d be on lookout for ADHD in the child at 4, 5, and 6, and new onset anxiety between 7 and 12 years. In the meantime, let’s make sure that the parents are parenting spot on with what we know to be best practices in parenting. Let’s put them on a pathway – because of family history – to do something personalized and preemptive for the child, because there may be genetic vulnerabilities. Just put a note in the kid’s file, and provide brief assessment and counseling along the way. Starting the dialog early makes it easier, and takes less time than bringing it up when problems have been present but unaddressed.” He adds that the two minutes it takes him to explain this is about how long it would take a primary care provider to explain why it’s important to find out about psychiatric history and parenting styles. Time is a real concern among medical professionals, but spending a little extra for this purpose is certainly worth it. “We worry about helmets and seatbelts; but not morbidity associated with behavior.”

If doctors are worried about the cost associated with early screening, it beats trying to treat ADHD many years later, when it may have all kids of other comorbidities associated with it. Walkup points out that it actually doesn’t take a lot of sophisticated training to pick out warning signs: Screening by non-medical, but well-trained, personnel is certainly possible. Early methods of treatment, before drugs are necessary, are effective, says Walkup: Small changes in parenting styles, a little extra attention in the classroom, and maybe a parenting class at the local Y or church might make a significant difference in a child’s experience and behavior. “There are lots of family and behavioral methods that work; it doesn’t take a whole lot. We KNOW when these conditions present themselves. We should be anticipating and preventing. It’s so comparatively cheap when we begin this early.”

Drug treatments are the still in many ways the standard care for ADHD – whether they should always be used or how they should be used is fodder for another article. Barbaresi feels that medication is still the most effective treatment we have, “and it’s safe when provided to an appropriately diagnosed child with good follow up care. But meds are not a standalone treatment. Changes in the way child is taught, and the ways behavior is managed at home and school, are essential. Still, we always get asked, ‘is there a non-medication treatment to make my child’s ADHD symptoms disappear?’ And the answer is still, ‘no.’”

Changing our views of ADHD won’t happen over night. Just like with depression or any other mental health disorder, public (and media) perception still plays a big role. But hopefully, as we get a better handle on what mental health disorders are all about, we’ll shed the stigma and welcome treatment a little more. As Walkup says, “If you have a problem and take care of it, there’s no stigma. But if you have a problem and don’t take care of it, then there’s stigma.”

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I don’t know, I find myself still solidly in the camp of “overblown and over-sensationalized.” However, it’s hard to combat the evidence with my feelings alone. The staggering number of children diagnosed with ADHD that go on to develop other disorders certainly suggests that there is SOMETHING going on. At this point, I’m left with two questions.

1. Have there been actual, verifiable treatment methods/plans that help to eliminate ADHD in children? Do the effects of these treatments persist into adulthood? (ie, Bob had ADHD as a child, and was diagnosed/treated effectively and did not develop any other associated illness as an adult.)

2. Is it more realistic to look at ADHD as a disease/illness in itself, or a symptom/precursor to the others? (Depression, anxiety, etc.)

I don’t know the answers, because, as I said, I’m pretty solid in my beliefs. Despite that, the facts and numbers presented in this article based on the study certainly demand a second look.

There is no “cure ” for ADHD however with therapy at an early age and meds it can be managed and as they grow older they learn how to handle and deal with things better. SOme may even be able to go without meds but they still have ADHD.

In thought the Same thing James, but I know for a fact my son has the impulsive, anxious form of ADHD. I believe it is due o underdevelopment of the nervous impulses that help with nervous and decision making control. So far I have one my research and related my son getting this through his dads genes (he had ADHD). I also find that my son was a mouth breather through the ages of 1 to 5 due to I diagnosed allergies and tonsil/android issues. Breathing through the mouth versus the nose can cause a lack of deep sleep and cause the body not to fully develop.. He also was on a long string of antibiotics prior to his tonsillectomy and I believe this may be another contributing factor.

I have to agree with this article…I do not believe ADD ADHD is NOT just over diagnosed. It is a real & serious chronic problem. It may seem like there are more cases now for a few reasons. #1 We as a society are more educated about ADHD & are better qualified to see it.

#2 The amount of Alcohol, Marijuana, & other drugs being used over the last 100 years up to today are encouraging more mental issues in our family lineages causing a change in our DNA . There is definitely something going on with all of the many types of mental illness effecting our population.

#3 could be just a part of natural evolution. look at our lives today compared to just 100 yrs ago, technology has jumped 1000 fold. everything is faster. Perhaps ADHD is a Natural progression of the human brain to keep up with all other types of “quick progression” we are witnessing.

I think it is just time for society to look at ADHD in a different manner.Realize that not all Men are created equal, we all learn differently so it is just plain WRONG to expect the same results from everyone or else! Early recognition is key to not being labeld “Bad” or “Troubled” which just leads to poor self image down the road.

As somebody that has what was referred to as the “malignant” type, I applaud the research. I was diagnosed back in middle school, however, my parents and I (yes I was included) made the decision not to go on medications because of the stigma it created and the potential issues it could cause in my educational career if I was singled out as having a learning disability (which ADHD is recognized as). Yes, I made it through high school graduating at the top of my class without using meds, however, I did experience some of the other issues associated with impulsiveness. It continued through college — poor, rash decisions due to not being medicated nor wanting to be medicated.

After college, I worked as an engineering consultant — phenomenal job — extremely high pay, international travel, expat assignment, etc. Yet again, ADHD played a role — the impulsiveness causes one to get bored and distracted constantly, which after 4 years, I was distracted and bored with the position and left to pursue my MBA. Again, completed that while not being medicated, but after working as a CMO, I got bored with that as well fairly quickly.

Now, in medical school, in my early 30s, I realized that I needed to be medicated to succeed. I noticed a massive change in my behavior when medicated — more focused, made fewer rash/inappropriate decisions, etc. Sometimes, I wish the stigma surrounding ADHD wasn’t there when I was in college because maybe I wouldn’t have made some of the stupid choices I did…

As someone who has done extensive research on ADHD (for several reasons), it is a disability but it is NOT recognized as a ‘learning disability.’ You can get an IEP and/or a 504 if needed, but again, it is NOT considered a LD.

I followed the link back to the web publication of the study because I wanted to find out what medical and/or therapeutic treatment the ADHD group received when they were children. I’m pretty surprised to find no mention of the treatment.

Interventions can have a significant effect on outcomes, I don’t understand what use the study is without it. For example – an extreme example, perhaps all ten of those ADHDers who are presently incarcerated received no treatment and 90% of those who were ADHD -and are now not ADHD- received family therapy?

Reading this report is like reading a study on the long term effects of pneumonia without including whether the patients received antibiotics or not!

WOW. I was right there agreeing with the article until I read, ‘is there a non-medication treatment to make my child’s ADHD symptoms disappear?’ And the answer is still, ‘no.’’

THAT is ridiculous and THAT is NOT true. Stop pushing big pharma down everyone’s throat. This is why I cannot stand mainstream media, agenda… agenda… agenda.

Interesting that I have a family history of ADHD. Myself, my brother, my dad, an aunt, several cousins… and now my 5 year old son. I have been monitoring him for the last couple of years.

He’s always had a well balanced diet, very little junk. He, like most any kid, thrives off structure. He actually gets plenty of sleep, bed at 7:30 and wakes at 6:30. If he has a couple of nights that he can’t sleep he gets his body reset with 1/2 or 1 mg of melatonin. He gets a GOOD vitamin (not crap bought at the store with fillers in it). He gets plenty of exercise (he will be starting martial arts as well because it’s one of the best things a kid with ADHD can do). He also sees a therapist every other week. Limited screen time to maybe a couple of hours a week, a big maybe. It works great!

He did start to go downhill the last couple of months in 2012. As to the research I did about ADHD and a gluten free diet (per Doctors and specialists and nutritionists who look behind a pill for help) and decided to try it. My son has always ate organic and I tries to stay away from junk food. Now we have gone to a clean eating and gluten free diet and I can assure you his ADHD symptoms did a complete 180. His teachers are amazed. His therapist is amazed. His own pediatrician who didn’t believe he should be on a gluten free diet a year ago when I asked, has now medically put him on a gluten free diet after hearing about all the results.

On top of that I know several people who have said their children have been CURED of ADHD by going to Brain Balance. I have spoke to them, they have NO reason to lie. I also know someone who’s daughter was severely autistic, and after this Brain Balance center she can now do things for herself and hold actual conversations with people… which she could do neither before. There are books out about it, they’re work the $20 to read them. Everything in them makes sense.

They are treating ADHD with out dated methods, but they refuse to look at alternatives. Doctor’s always fall back on meds, meds, meds. NO NO NO! That is the EASY way out. Our children deserve better, and they deserve the effort.

Frankly, the most reliable research that I’ve read is the stuff that usually ends with, “what works for some children, may not for others… what affects someone’s ADHD may not affect another person’s ADHD.” Gluten free was a miracle for my son. He still shows his symptoms but they aren’t nearly as bad and they are much more manageable now WITHOUT MEDS!!!!!

Oh, and the thing about meds is… they don’t make ADHD symptoms disappear either. That’s a myth. They may mask SOME. But it’s simply a mask, and it doesn’t work on everything. Plus, it can create all new issues. Some meds can cause ticks, some meds may cause other behavioral and emotional problems.

EDUCATE YOURSELVES PEOPLE… and look at other sources besides mainstream media. Don’t be a sheep.

Thanks for writing. Just to be clear, it wasn’t my saying that there aren’t good non-med treatments — that was one of the doctors I spoke with, the author of that particular article. Behavioral interventions can certainly help, although there’s just less evidence, as I understand it, for them than medications. I’d bet that gluten-free diets don’t work for all kids, just as meds don’t work for all kids. But I’m certainly glad you found something that works for your son; I definitely think that if meds can be avoided, they should be. But for some, they are the only way. Thanks again for writing.

I have been the more “malignant” type and take old school dexedrine tablets still. I will say that I see a lot of lazy people getting these so they can clean and get enough time for candy crush. I am hyper, I wait until it wears off to work. I see so many girls on adderall that have pressured speech (like me without it) loud, obnoxious etc. I have since taking this drug mastered the languages I grew up with, learned another at 8 then at college learned 3 more within 2 years, good enough to be fluent in a month or two in a place that spoke them (German/English, Farsi, Spanish, Italian and French). I make a killing as a Farsi interpreter. I travel all over the world… earlier this year, it was Saudi Arabia, Estonia and South Korea. It is the best job ever and it is a degree that is very useful and as a dual citizen to Germany would be recognized (after a few classes there too) I am an undergrad in German and International Relations and I speak Farsi and every place I have inquired about has been trying to reel me in. This is one of those jobs that is listed with Engineering and Tech (I wanted to be a psych major at first LOL)… This medication is old, nobody gives it to people because it was a diet pill but I have been on the same dose for 15 years.

With that said, my mom was lazy so she loved me in a quiet state so she didn’t have to listen to me. She was a pill pusher. The founding mother of the Adderall Generation. I take 10-30 mg 4-5 day (max of 150). I had to pay for genetic testing that was almost $2k because these are all that work for me and they last two hours… it ended up showing that 150 mg doses metabolized so fast that it was around the 45 mg to 60 mg bioavailability, which is in the normal range. Whether my mom was lazy or not, this drug slows me down, I am a health nut and consume no other drugs but organic naturally occurring algae and coq10.

If I stop like the know it alls say, I’d act 14, steal, fight and I am 33 and too old for this type of thing. As far as “crashing”… I know it wore off because I am hungry. My health is in perfect shape and I don’t do drugs.

I DO agree that a lot of people are on these medications that don’t need them… and every time a new drug they are pushing as non addictive (Vyvanse) that people are getting busted selling and getting high from… The skinny adderall girls too lazy to go on a diet, the druggies, the moms with kids that are either brats or of minimal IQ, Moms to clean the house better. I take this crap for social reasons. I plan to taper off but it will take 10 years because pills don’t teach the skills they provide and it takes forever to practice them… Plus, I can flip tongues like a pro hyperactive, as well.

In my experience with a family member who I became caregiver for, his psychologist at an attention disorder clinic, tested with QEEG and the indications of a “slow wave” and breaks in attention while tasking could be SEEN and evaluated! These wave patterns differed and once, there was a better result when the patient UN-medicated for the session! (Ritalin, Risperdal, Tenex, Vitamin D) Diet, rest, exercise, lab work to find deficiencies (Vitamin D notably), as well as medication and the behavior therapy etc…..it’s a case by case thing I think. Try looking up Vincent J. Monastra in Endicott, NY who is a specialist in attention disorders.

We had great success with the Feingold diet over 35 years ago. This material is playing the same song for the last 50 years that I know of. I also object to some of the conclusions that parenting is to blame. If that was true, how come when the chemicals are taken away the child is OK and the parents did not do anything else. There is a lot of money to be made by the different treatment modalities and that is the bottom line in all of this. The Feingold diet is free and that is why it is objected to by the professionals as they no longer can capitalize on this condition. A better method would to try to find out where the child is gifted and channel that child in that direction to achieve success and a path to follow to gain self esteem . I personally think that a lot of these” shooters” are frustrated adults that were repeatedly rejected and they are trying to get even for all the hurts and rejections they experienced in their lives from our society. Comments anyone?

Unfortunately, long term studies show that stimulant treatments, and even multi-modal aggressive treatment do not have satisfactory outcomes for almost half of those with ADHD (Satterfield, 2007). Meanwhile, the FDA is encouraging the testing of stimulant drugs on children under 6, in spite of no evidence that starting drug treatment earlier has better long term effects. And we are talking about drugs whose side effects include hallucinations, heart attack, and stroke. Can a 3-year old tell you if he is having hallucinations? My 7 year old was having them, and his neurologist said it was seizures in spite of negative EEG testing, so he continued on the drugs until he developed severe Tourette’s Syndrome at 8 … before doctors knew what that was. We took him off the drugs …. at least the hallucinations went away, so they were not seizures. Today I am so grateful he developed TS because it got him off the drugs, and we eventually found the Feingold Diet; today he has no symptoms at all.

I agree on parenting training for those children expected to be at risk, as well as more in-depth psychological testing, but you missed a few things important to diagnosis. While it’s true that ADHD “runs in families” some of this may not be genetic – it may be exposure of several generations to the same toxins. If it is recognized, it can hopefully be treated, or at least further damage may be prevented. Not only lead, but elevated levels of cadmium, arsenic, and even fluoride can cause behavioral changes (Blaylock, 2004; Ciesielski, 2012; Jiang, 2014). Deficiency of zinc, iron, and some of the vitamins have behavioral effects (Ahmed, 2007; Arnold, 2011; Konofal, 2005). Exposure to organophosphates can have behavioral effects (Bouchard, 2010). Ruling these things out first may prevent later tragedy.

Unfortunately, too many parents report to us that their child was recommended stimulants after a 5-minute consultation. We are not doctors, however. We teach the Feingold diet which some in the ADHD field brush off with referrals to the old 1982 meta analyses of the very old studies funded by the food additive industry. Even later reviews such as Cruz (2006) ignore new studies and reviewed the same bad old studies from the 1970s. The facts are that properly removing certain additives works (Bateman, 2004; Boris, 1994; Kamel, 2011; McCann, 2007; Rowe, 1994; Schab, 2004; Schmidt, 1997; Stevens, 2011; Uhlig, 1997) and adding certain vitamins often work as well as stimulants (Carlton, 2000; Schoenthaler, 1986, 1991, 1997, 1999, 2000). I have listed the full texts of some of these studies below, and I have all the others if anybody wants them, but I would have to give you the password, as they are not open studies. Some of the diets described in the research are difficult and restricted “few foods” diets, but at the Feingold Association, we have been getting the same results using a far less restrictive format; we don’t eliminate everything, just the worst things. Our Foodlist books are over 400 pages long and include acceptable brands of hot dogs, ice cream, and candy. This is a perfectly normal diet that can be offered as a first line treatment (with or without vitamins/minerals a la Carlton below). See more at http://www.feingold.org